68-1029 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ---------------- - -----`----- ---------- ---- ---------- ------------------- ----.-----------------_--------------I "' This Permit Expires 1 Year From Date Issued Date Issued 4_2-'-3--- 4 Application is hereby made to the San Joaquin Local Health'District for a permit to construct and install the work herein described. This application is made in compliance with County..Ordinance No. 549 and existing Rules and Regulations:, ' JOB ADDRESS/LOC T#ION . ------- --- r ---------- ------CENSUS TRACT -------------------------- Owner's Name ------ ------------ ----- , ----------------------------------•-------- ----- ---Phone ----- Address -------- --------` � city / Contractor's Name �u ryd---- ----- -------- License # ------- -,--- --- ------ Phone T_�-4KO Installation will serve: Residence ❑Apartment House ❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------ Number of living units:._.-.)..__ Number of bedrooms -7-----Garba-ge Grinder ------------ Lot Size ---------/Z......................_.._-- WaterSupply: Public System. and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a depz feet: Sand'❑ Silt 0�Clay E] -Peat E] Sandy Loam ,❑ Clay Loam 0 } Hardpan ❑ Adobe <&Fill Material ------------ If yes,type ---------------------------- �. F (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) 1• I NEW INSTALLATION: (No septic tank or seepage pit permitted -it public sewer is available within 200 feet,) PACKAGE TREATMENT f ] 'SEPTIC TANK [ ] Size-------_--I------------------------ ------------ Liquid Depth .-._-_____---_--------_ R Capacity `_,- e -------------------- Material---------------------- No. Compartments -----5------•-• -•--•- - p Y -- ---------- Type ° Distance to nearest Well -----------------------------1------Foundation ---------------------- Prop. Line ..._ •--- '� M LEACHING LINE { ] No. of f Lines ------------------------ Length of each line-------_-_------------ _ -- Total Length :-----_--- -.-------._--- 'D' Box ------------ Type Filter Material ------------- ------Depth Filter Material ---------------------------.._--------_.---- DistanceTto-nearest:•Wei l __-___-R----------------- Foundation ------------------------ Property ,Line]..___._................ SEEPAGE PIT [ ] Depth ...----------------- Diameter ---------------- Number ---------------------------- Rock Filled 'Ye's'-[J No 0 Water Table Depth ----------------------------------'`' .Rock Size E Ias " I �_ t R: kDistance to_neorest:.Well -------- \------------------?--....Foundation, ................- r--,Prop. Line -------- ------ ✓ (Prev; ` y �.T REPAIR ADDITION Prev: Sanitat�on Permit�# _.-_......_.___-__-�_________________._ Date _.__:......................4 .... Septic Tank (Specify Requirements) ------------ --------------------- ---____-- ._-�- " ' ------ ---------------------- Field {]Specify Requirements) t `E' s°' ------------- -----F ' } t j ! Ile ---------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be doner.iri accordance with Son Joaquin ' County Ordinances, State Laws, and Rules and Regulations of the San�Joaquin Local Health District. Home ownor or licen- sed agents signature certifies the following: \ I "I certify that in the performance of thV work}for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compenscition laws of California." Signed - ---------------- Owner B ► Y r -- ------ -Title ..---- ---------- f ------ - .j --------------------------- ----------------------- (Ifowner Qa FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �' == -= ,±0` DATE "' -- ------------------ BUILDING PERMIT ISSUED .--- ----cl-- ��V-a ,-:.:. -------DATE -------------•------------- ---- ------- - -- - ADDITIONAL COMMENTS -------- --------------------------------------- --- ------ ----------------------------------------------------= •' z------------------------ -------------------------------------------------------------- - ----------------- ---------------------------- ----- -- - ------- Final Inspection by: -----------F,!!,-,J--A e2Z-- _�� --------------- Date _.�.2.'��t�5�_ SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68`Rev.5M.